Healthcare Provider Details

I. General information

NPI: 1649379322
Provider Name (Legal Business Name): HICKAM PHCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 SCOTT CIR
HICKAM AFB HI
96853-5399
US

IV. Provider business mailing address

755 SCOTT CIR
HICKAM AFB HI
96853-5399
US

V. Phone/Fax

Practice location:
  • Phone: 808-448-6242
  • Fax: 808-448-6740
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332000000X
TaxonomyMilitary/U.S. Coast Guard Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HECTOR MORALES
Title or Position: MGR PHRMCY OPERATIONS CNTR
Credential:
Phone: 210-221-8443